Pregnancy denial, also known as cryptic pregnancy, refers to a lack of awareness of being pregnant, often until late in the pregnancy or even childbirth.
It is a more common phenomenon than generally realized, occurring in an estimated 1 in 500 pregnancies.
Women affected are usually mentally and physically healthy. The underlying causes are complex and multifactorial.
Key Facts:
- Pregnancy denial occurs in about 1 out of every 500 pregnancies
- Most women with pregnancy denial are psychologically and physically healthy
- Underlying reasons are complex, involving psychological, social, biological, and evolutionary factors
- Insufficient or ambiguous signs of pregnancy, as well as personality characteristics, likely play a major role
Source: Curr Psychiatry Rep. (2023)
What is pregnancy denial? (Overlooked pregnancy)
Pregnancy denial, or overlooked pregnancy, refers to a lack of awareness of being pregnant.
In severe cases, women remain unaware until late in the pregnancy, even until childbirth.
This phenomenon has puzzled health professionals and researchers for decades.
Why do some women, despite clear physical signs and bodily changes, fail to recognize that they are pregnant?
Pregnancy denial used to be viewed primarily as a pathological issue resulting from trauma or psychiatric disorders.
However, research in recent years indicates that in the majority of cases, affected women do not have underlying mental health or trauma issues.
The reasons behind the phenomenon appear to be complex and multifactorial.
How common is pregnancy denial? (Estimated prevalence)
Several studies conducted in Europe and the USA estimate that pregnancy denial or unperceived pregnancy occurs in around 1 in 500 pregnancies.
This makes it more common than rarer pregnancy complications like uterine rupture or rhesus hemolysis.
It is also estimated to be twice as common as having naturally-conceived triplets.
Trauma & Psychiatric Disorders in Pregnancy Deniers
In the past, pregnancy denial was frequently attributed to trauma or underlying psychiatric issues.
The assumption was that a history of abuse, trauma during conception, or conditions like depression led women to repress or deny the pregnancy psychologically.
However, current evidence does not seem to support this assumption.
In recent case studies, trauma histories and psychiatric disorders were only minimally reported or absent altogether.
One literature review found that out of 12 published case reports over the past decade, only 5 involved women with underlying mental health conditions.
The remaining women exhibited no psychiatric symptoms and had no known trauma histories.
A large case-control study similarly concluded that while some women with pregnancy denial had previous psychiatric histories, the majority (over 75%) were mentally healthy.
Trauma and psychiatric issues therefore do not adequately explain most occurrences of pregnancy denial.
Possible Reasons & Contributing Factors to Pregnancy Denial
So if psychiatric disorders and trauma do not underlie most cases of pregnancy denial, what does explain this phenomenon?
Researchers propose several contributing reasons:
Insufficient Signs of Pregnancy
A major factor seems to be ambiguous or insufficient physical signs of pregnancy.
Symptoms like nausea, tender breasts, fatigue, and abdominal swelling are common in early pregnancy but are not definite proof.
Women with irregular menstrual cycles or those taking oral contraceptives may miss these signs entirely.
Bleeding during pregnancy can also mask symptoms.
Studies indicate that most women who remain unaware of their pregnancy lack typical symptoms or only experience them mildly.
Using contraceptives also raises the risk. Their bodies provide few cues to indicate a pregnancy.
Personality Factors
Personality likely also plays a role. Women prone to pregnancy denial may have diminished self-awareness about their bodies and poor recognition of their own feelings and emotions.
They tend to downplay symptoms and are firmly convinced they cannot be pregnant, so they do not look for signs.
Some case studies describe affected women as having inferior coping abilities.
Psychological Defense Mechanisms
Pregnancy denial may also represent unconscious psychological defense mechanisms.
In women facing stressful life situations or potential stigma around pregnancy, repressing awareness of the pregnancy may feel protective, even if subconscious.
Two case studies describe young women who were unprepared for motherhood.
Remaining unaware of the pregnancy was likely beneficial given their circumstances.
Evolutionary Explanations
Some researchers propose evolutionary explanations.
Humans have evolved psychological and physiological mechanisms to signal pregnancy, which prompt mothers to protect the fetus.
But when facing significant costs or threats from pregnancy, it may instead become adaptive for the woman’s body to “turn down” these signals, limiting risks and investment in the pregnancy.
Pregnancy denial allows women to offload physical costs of pregnancy while still enabling the fetus to develop.
So while counterintuitive, lacking awareness may have evolutionary advantages in certain environmental contexts.
This may explain why it persists at a low rate in the population rather than being selected out evolutionarily.
Navigating Pregnancy Denial in Healthcare Settings
The current evidence indicates that pregnancy denial is a complex phenomenon that can affect women from all backgrounds, regardless of mental health status.
Healthcare providers should therefore not make assumptions about underlying trauma or psychopathology when encountering cases.
However, they can be aware that women with irregular cycles, those taking contraceptives, and multiparous women may face higher risks of overlooked pregnancy.
Personality characteristics like poor self-recognition and coping abilities may also contribute. Providers can look for these factors when assessing patients.
Most importantly, the possibility of an unperceived pregnancy should not be ruled out in any woman of reproductive age, regardless of risk factors.
Unexplained or ambiguous symptoms need to be thoroughly investigated so cases are not missed.
Potential Problems Arising from Pregnancy Denial
Pregnancy denial can lead to a range of issues that may affect the health and well-being of both the mother and the child. It’s crucial to understand these potential problems to provide appropriate care and support.
Lack of Prenatal Care
- Delayed Medical Attention: Women unaware of their pregnancies miss crucial prenatal check-ups and screenings, potentially overlooking health issues that could be managed if caught early.
- Impact on Fetal Development: Lack of prenatal care can lead to undetected complications, affecting the fetus’s growth and development.
Psychological Impact
- Emotional Distress: Discovering a pregnancy late can cause significant psychological distress for the mother, leading to feelings of shock, denial, and anxiety.
- Preparation: The sudden realization of pregnancy leaves little to no time for psychological preparation for childbirth and motherhood, potentially affecting maternal bonding and mental health.
Physical Health Risks
- Lifestyle Choices: Without knowledge of pregnancy, women might continue with lifestyle choices detrimental to fetal health, like smoking, drinking, or taking certain medications.
- Complications During Delivery: Unmonitored pregnancies can lead to unforeseen complications during labor and delivery, putting both the mother and the baby at risk.
Social and Legal Implications
- Stigma and Judgment: Women who deny or are unaware of their pregnancies may face social stigma, misunderstanding, and judgment, impacting their mental well-being.
- Childcare Preparedness: The lack of time to prepare for the child’s arrival can lead to logistical and legal challenges, including immediate childcare needs and potential involvement of social services.
Long-term Effects on the Child
- Health Issues: Children born from denied pregnancies might face health issues stemming from inadequate prenatal care.
- Emotional and Developmental Impact: The shock and lack of preparation can affect the initial bonding and attachment between the mother and the child, potentially leading to long-term emotional and developmental consequences.
Strategies for Mitigation & Support in Pregnancy Deniers
Education and Awareness: Increasing awareness about pregnancy denial among healthcare providers and the public can lead to earlier detection and intervention.
Nonjudgmental Support: Providing empathetic and nonjudgmental support to women experiencing pregnancy denial is crucial for their psychological well-being and effective care.
Integrated Care Approaches: Collaborative care models involving obstetricians, psychologists, and social workers can ensure comprehensive support for the mother and the child.
Post-partum Support: Offering post-partum psychological support and parenting resources can help mothers navigate the sudden transition to motherhood.
Remaining Questions in Pregnancy Denial
- What specific hormonal or physiological factors distinguish denied pregnancies, where signs seem muted?
- How does pregnancy denial relate to false pregnancy (pseudocyesis) – the opposite phenomenon where women show all signs of pregnancy despite not actually being pregnant?
- Can we identify broader evolutionary contexts and pressures that make lacking pregnancy awareness adaptive in ancestral environments?
- What screening tools could help identify women at higher risk of denying pregnancy, enabling early detection and support?
Pregnancy Denial Can Impact Any Woman
Pregnancy denial is a complex phenomenon that current evidence suggests can potentially affect any woman.
The popular assumptions that trauma or psychiatric issues underlie most occurrences are not supported.
Instead, reasons seem to be multifaceted – a combination of insufficient physical symptoms, personality tendencies, unconscious psychological defense mechanisms, and subtle evolutionary adaptive pressures.
By better understanding these various factors, providers can deliver insight-based care to affected women.
More research is still needed to fully unravel the biopsychosocial mechanisms causing some women to remain unaware of the life developing within them.
References
- Study: Pregnancy Denial: Toward a New Understanding of the Underlying Mechanisms
- Authors: Chechko et al. (2023)
